By MIKE MAGEE

Dr. Linda Rosenstock has an M.D. and M.P.H. from Johns Hopkins, and was a Robert Wood Johnson Clinical Scholar. She is currently Dean Emeritus and Professor of Health Policy and Management at UCLA’s Fielding School of Public Health, but also spent years in government, and was on President Obama’s Advisory Group on Prevention, Health Promotion and Integrative and Public Health.

In the wake of the release of Justice Alito’s memo trashing Roe v. Wade, she was asked to comment about the status of abortion in America. Here is what she said:

“The broader the access to proven family planning methods, the lower the unintended pregnancy rate and the lower the abortion rate. We can’t underestimate the role of educating and empowering women – and men – about these issues.”

These are not simply the opinions or insights of a single health expert. They are backed up by the following facts:

1. Since 1981, abortion rates in U.S. women, age 15 to 44, have declined by nearly two thirds from 29.3 per 1000 to 11.4 per 1000.

2. Approximately half of all pregnancies in the U.S. are unintended.  Of those unintended, approximately 40% of the women chose to terminate the pregnancy by abortion – either procedural or chemically induced.

3.  The decline in the number of abortions has coincided with increased access to long-acting reversible contraception, including IUD’s and contraceptive implants. These options are now safe, increasingly covered by insurers, and more accessible to at-risk populations.

4. The increasing inclusion of sex education in middle school and high school curricula has been accompanied by a decline in high school sexual activity by 17% between 2009 and 2019.

5. There were 629,898 abortions recorded by the CDC in 2019. For every 1000 live births that year, there were 195 other women who chose to terminate their pregnancies. Almost half of the 1st trimester abortions are now chemically induced through Plan B-type pills.

What is clear from these figures is that knowledge and access to contraception is the best way to decrease the number of abortions in America.

We’ve known this for some time. But when push comes to shove, the actions of Right to Life advocates including conservative Catholics and Evangelical Christians, have (by their actions) revealed that a broader agenda than simply eliminating abortions is at work here. That broader agenda includes patriarchal control over women’s sexuality and birth rates in America.

Overcoming this opposition requires excellent messaging, service acquisition, information support, privacy, and short-term follow-up. These would seem to be well within the wheelhouse of health teach entrepreneurs.

That contraception is safe and effective, and reinforces women’s autonomy and entry in the workplace, is no longer debatable. The options for birth control have expanded as well. Contraceptive reversible implants are now chosen by 16%, IUDs by 21%, and operative tubal ligation by 28%.

If one looks at the track record of those leading the charge to eliminate Roe v. Wade (in and out of the Supreme Court), including De Santis level book sanctions, pedophilia fantasia, insistence that failed “abstinence-only” sex education works, and highly organize assaults on women’s services provided by Planned Parenthood, it is reasonable to assume that Alito’s assurances that overturning privacy precedents applies only to abortion are not trust worthy.

Justice Alito’s reliability should be viewed through the lens of the testimony provided by Justices Kavanaugh, Barrett, and Gorsuch, under oath, on the topic during their confirmation hearings. Alito and these co-signers on his recent draft assure that Roe v. Wade and Planned Parenthood v. Casey are different since “[a]bortion destroys . . . potential life” and “none of the other decisions cited by Roe and Casey “involve the critical moral question posed by abortion.”

But the history and performance of these five Justices, their original and current supporters, their documented religious orthodoxy, and the web of conservative schools and think tanks that nurture their well-entrenched biases all suggest “buyer beware.”

Other recently granted rights under these privacy precedents include:

• The right to interracial marriage (Loving v. Virginia),
• The right to obtain contraceptives (Griswold v. Connecticut)
• The right to engage in private, consensual sexual acts (Lawrence v. Texas)
• The right to same-sex marriage (Obergefell v. Hodges).

Paraphrasing the proverb from a book called The Court and Character of King James by Anthony Weldon, 1651,: “Fool me once, shame on you. Fool me twice, shame on me.”

Mike Magee, MD is a Medical Historian and Health Economist, and author of  “CodeBlue: Inside the Medical Industrial Complex”